| Name |
|
| I.D. Number |
|
Campus Box
(Or local address) |
|
| Phone Number |
|
| Expected Grad Date |
|
| Outside employment hours per week |
|
| Major |
|
| INSTRUCTIONS: Please state your request clearly and specifically. Provide the committee with as much pertinent information as possible. Please indicate exactly what courses you are currently enrolled in and your anticipated schedule for each session of the coming year. Fall, Spring and Summer. After the appropriate signatures are obtained, mail this form to the Registrar, who will notify you of committee action. |
| I hereby petition:
|
| What is the rationale for your request?
|
| In cases which involve departmental requirements, the petition should be reviewed by the faculty within the department. The faculty recommendation(s) should be recorded in this space.
|
| |